Computed Tomography Imaging Characteristics of Non–Small-Cell Lung Cancer With Anaplastic Lymphoma Kinase Rearrangements: A Systematic Review and Meta-Analysis

• Published in: Clinical lung cancer 2019-09, Vol.20 (5), p.339-349
• Main Authors: Mendoza, Dexter P., Stowell, Justin, Muzikansky, Alona, Shepard, Jo-Anne O., Shaw, Alice T., Digumarthy, Subba R.
• Format: Article
• Language: English
• Subjects: Anaplastic Lymphoma Kinase - genetics; Carcinoma, Non-Small-Cell Lung - diagnosis; Carcinoma, Non-Small-Cell Lung - genetics; Carcinoma, Non-Small-Cell Lung - pathology; Epidermal growth factor receptor mutation; Gene Rearrangement; Humans; Lung - diagnostic imaging; Lung Neoplasms - diagnosis; Lung Neoplasms - genetics; Lung Neoplasms - pathology; Metastasis; Mutation; Radiogenomics; Radiology; Tomography, X-Ray Computed
• ISSN: 1525-7304; 1938-0690
• DOI: 10.1016/j.cllc.2019.05.006

Several studies have suggested that non–small-cell lung cancer (NSCLC) patients who harbor anaplastic lymphoma kinase (ALK) rearrangement might have different imaging features compared with those without the rearrangement. The goal of this work was to systematically investigate the computed tomography (CT) imaging features of ALK-rearranged NSCLC. We searched published studies that investigated CT imaging features of ALK-rearranged NSCLC compared with ALK-negative, including epidermal growth factor receptor (EGFR)-mutant and ALK/EGFR-negative, NSCLC. We extracted clinicopathologic characteristics and CT imaging features of patients in the included studies. Features were compared and tested in the form of odds ratios (ORs) or weighted mean differences at a 95% confidence interval. Twelve studies with 2210 patients with NSCLC were included. Compared with ALK-negative NSCLC, ALK-rearranged NSCLC was more likely to be solid (OR, 2.37; P < .001) and less likely to have cavitation (OR, 0.45; P = .002). In advanced stages, patients with ALK-rearranged NSCLC, compared with EGFR-mutant NSCLC, were more likely to have lymphadenopathy (OR, 3.47; P < .001), pericardial metastasis (OR, 2.18; P = .04), pleural metastasis (OR, 2.07; P = .004), and lymphangitic carcinomatosis (OR, 3.41; P = .02), but less likely to have lung metastasis (OR, 0.52; P = .003). Compared with ALK/EGFR-negative NSCLC, ALK-rearranged NSCLC was more likely to have lymphangitic carcinomatosis (OR, 3.88; P = .03), pleural metastasis (OR, 1.89; P = .02), and pleural effusion (OR, 2.94; P = .003). ALK-rearranged NSCLC has imaging features that are different compared with EGFR-mutant and ALK/EGFR-negative NSCLC. These imaging features might provide clues as to the presence of ALK rearrangement and help in the selection of patients who might benefit from expedited molecular testing or repeat testing after a negative assay. We analyzed all published research and compared the imaging features of anaplastic lymphoma kinase (ALK)-rearranged non–small-cell lung cancer (NSCLC) patients with those without ALK rearrangements. This meta-analysis included 12 studies with 2210 NSCLC patients, 456 of whom had ALK rearrangement. We found that ALK-rearranged NSCLC patients have distinct clinical and imaging features, which might assist in selecting patients who might benefit from expedited or repeat molecular testing when necessary.